These will be completely remote positions, working entirely from the Nurse's home. The Nurse will ... Professional Utilization Review (CPUR) program * Certified Case Manager (CCM) issued by the ...
These will be completely remote positions, working entirely from the Nurse's home. The Nurse will ... Professional Utilization Review (CPUR) program * Certified Case Manager (CCM) issued by the ...
These will be completely remote positions, working entirely from the Nurse's home. The Nurse will ... Professional Utilization Review (CPUR) program * Certified Case Manager (CCM) issued by the ...
These will be completely remote positions, working entirely from the Nurse's home. The Nurse will ... Professional Utilization Review (CPUR) program * Certified Case Manager (CCM) issued by the ...
Exercise Integration and Readiness Coordinator
Honolulu, HI · On-site +1
$86K - $198K/yr
Remote Work: No Job Number: R0247104 Location: Honolulu,HI,US Share job via: Share Exercise ... Support asset utilization planning, reconstitution activities, lessons learned collection, and ...
Exercise Integration and Readiness Coordinator
Honolulu, HI · On-site +1
$86K - $198K/yr
Remote Work: No Job Number: R0247104 Location: Honolulu,HI,US Share job via: Share Exercise ... Support asset utilization planning, reconstitution activities, lessons learned collection, and ...
Remote Utilization Management information
What is remote utilization management?
Remote utilization management is a process in which healthcare professionals, such as nurses or case managers, review and assess the necessity, efficiency, and appropriateness of medical services—often from a remote location. These professionals typically work for insurance companies, hospitals, or healthcare organizations to ensure that patients receive the right care while controlling costs. By working remotely, they use electronic health records, phone calls, and other digital tools to collaborate with providers and patients. This role helps improve healthcare quality and cost-effectiveness while allowing employees flexible work arrangements.
What are the key skills and qualifications needed to thrive in remote utilization management?
Success as a Remote Utilization Management Nurse requires a registered nursing license, clinical experience, and strong knowledge of medical necessity criteria and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically necessary. Exceptional communication, critical thinking, and organizational skills help professionals excel in evaluating cases and coordinating with providers remotely. These skills are crucial for ensuring appropriate care, cost-effective resource use, and regulatory compliance in a remote healthcare setting.
How does a remote utilization management professional typically collaborate with healthcare providers and insurance teams?
Remote Utilization Management professionals frequently interact with both healthcare providers and insurance teams through secure digital platforms, phone calls, and virtual meetings. They review patient records, assess the necessity of medical services, and communicate their recommendations or authorization decisions. Effective collaboration requires clear documentation, timely responses, and strong communication skills to ensure that care is both medically appropriate and cost-effective. While the work is often independent, regular coordination with interdisciplinary teams is essential for maintaining high-quality patient outcomes and adhering to regulatory standards.
What is the difference between Remote Utilization Management vs Remote Case Management?
| Aspect | Remote Utilization Management | Remote Case Management |
|---|---|---|
| Credentials | RN, LPN, or licensed healthcare professionals | RN, LPN, or social workers |
| Work Environment | Healthcare facilities, insurance companies, telehealth | Healthcare providers, insurance, community agencies |
| Industry Usage | Insurance, healthcare, telehealth | Healthcare, social services, insurance |
| Primary Focus | Reviewing medical necessity, authorizations | Coordinating patient care, support services |
Remote Utilization Management primarily involves reviewing medical necessity and authorizations, while Remote Case Management focuses on coordinating patient care and support services. Both roles require healthcare credentials and are used within healthcare and insurance industries, but they serve different functions in patient care and resource allocation.
What are the most commonly searched types of Utilization Management jobs in Hawaii?
The most popular types of Utilization Management jobs in Hawaii are:
What are popular job titles related to Remote Utilization Management jobs in Hawaii?
For Remote Utilization Management jobs in Hawaii, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management jobs in Hawaii look for?
The top searched job categories for Remote Utilization Management jobs in Hawaii are:
RN - Utilization Management
Honolulu, HI • Remote
Spectrum Healthcare Resources •
Health Care and Social Assistance • 1 - 5K employees1,001 - 5,000 employees
Full-time
Posted 22 days ago
Job description
Job Description
Spectrum Healthcare Resources has a need for a Utilization Manager Registered Nurse (UMRN). These will be completely remote positions, working entirely from the Nurse's home. The Nurse will be reviewing cases, educating patients on appropriate care and managing health care costs for the dependents of our Nation's Active Duty and eligible retirees.
The Nurse will be working remotely Monday through Friday, 8 hours per day.
Requirements
- Bachelors Nursing Degree
- At least one active state nurse license, preferably compact state licensure
- At least 2 years' experience working as a UMRN, preferably in a remote or hybrid environment.
- Possess current certification in either
- Completion of an accredited Certified Professional Utilization Review (CPUR) program
- Certified Case Manager (CCM) issued by the Commission for Case Manager Certification.
--OR--
- Possess two (2) years of full-time broad based registered nurse experience in a utilization management review or a case management setting within the preceding five (5) years. Notwithstanding the aforementioned experience requirements, the HCWs must have pertinent clinical experience within the past two (2) years sufficient to demonstrate current clinical competency for the setting and procedures required by this contract.
- Highly organized, self-directed worker able to function in a high-volume environment without distractions.
- Strong verbal and written communication skills.
- Proficient level of experience with Microsoft Office applications and strong technical aptitude.
- Must have access to secure, high speed internet.
Company Overview:
Spectrum Healthcare Resources (SHR) was established in 1988 to deliver systems and processes designed to meet the unique needs of Military and VA Health Systems. SHR is a leading organization that provides physician and clinical staffing and management services to United States Military Treatment Facilities, VA clinics and other Federal Agencies through various contracting vehicles. A Joint Commission Health Care Staffing Services firm, SHR is the military staffing division of TeamHealth, a Nationwide organization that serves 850 civilian and military hospitals with a team of 9,600 affiliated health care professionals. EOE/Disabled/Veterans
Location : LocationUS-HI-HonoluluRecruiter : Full Name: First LastJoseph DayDirect phone number314-744-4138Recruiter : Emailjoseph_day@spectrumhealth.comEmployment Type: OTHER
About Spectrum Healthcare Resources
Sourced by ZipRecruiter
Spectrum is a leading organization that provides program management and physician and clinical staffing services to United States Military Treatment Facilities, VA Clinics and Federal Agencies. We are dedicated to the markets we serve, leading our organization’s experience for almost three decades.
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Saint Louis, MO, US
Year founded
1988